How to Spot Fraud

Fraud against the government is often reported by individuals who are not actively looking for fraud. Instead, they come across some suspicious activity or notice a pattern of wrongdoing in their daily life. This is why most cases of reported fraud involve employees who see their own company, other employees, or management commit fraud in the workplace.

When someone witnesses fraud against the government or government agencies, a whistleblower can report the fraud and be rewarded for taking a stand against fraud. These whistleblower lawsuits allow the individual who exposed the fraud to share in the amount of damages and penalties recovered by the government.

Fraud against the government may include healthcare fraud, Medicare fraud, Medicaid fraud, Tricare fraud, government contractor fraud, income tax fraud, sales tax fraud, higher education fraud, pharmaceutical company fraud, and other types of fraud involving government programs. If you suspect government fraud in your workplace, talk to your experienced whistleblower lawyer.

Examples of Fraud

Fraud against the government may be going on all around you. However, without knowing what fraud looks like, you may never notice it. Examples of fraud against the government may include:

  • Billing the government for non-conforming goods
  • Overbilling the government for services
  • Paying illegal kickbacks for referrals or contracts
  • Selling the government defective goods
  • Falsifying and submitting official records or documents
  • Misrepresenting sales tax figures

Experienced professionals and employees who understand their job are in the best position to identify fraud around them. Understanding industry regulations and standard practices make it easier to notice when something is out of the ordinary.

Signs of Possible Fraud

Fraud often occurs when the individual committing fraud has the opportunity to commit fraud, is under financial pressures, and uses rationalization to justify their actions. This is also known as the fraud triangle. 

Fraud can involve a one-time activity but it often involves an ongoing scheme to defraud the government and taxpayers. Many people who commit fraud start off small then get greedy, taking more and more until they are eventually caught. It may be easier to identify fraud when it becomes a pattern, increasing in scope and value. Some signs of possible fraud may include:

  • Sudden change in company income or expenses
  • A sharp increase in referrals to a particular provider
  • A sharp increase in prescribing a certain medication
  • Medical billings that do not comport with what time or skill would allow
  • Billing for unnecessary or unnecessary home health services
  • Missing documents
  • Property/inventory shortages
  • Increased or excess purchases
  • Duplicate payments
  • Duplicate books
  • Double versions of government forms regarding services provided
  • Sudden change in invoice volume
  • Invoices for just under the amount that requires management approval
  • Changes in billing practices

Signs of Healthcare Fraud

Healthcare fraud is one of the most common areas of whistleblower fraud. The largest government healthcare programs include Medicare, Medicaid, and TRICARE. As a result of these massive, and often bureaucratic programs, government health care is a common target of fraud. Service providers, doctors, and even hospitals may take advantage of the complex nature of government healthcare to enrich themselves at the expense of taxpayers.

Examples of healthcare fraud may involve:

  • Billing for services that were never provided
  • Overbilling for services
  • Billing for “phantom patients”
  • Billing for unnecessary procedures
  • Misrepresenting the patient's complaint or illness
  • Altering forms and medical records
  • Treating illegally referred patients
  • Prescribing unnecessary medications
  • Prescribing unnecessary tests
  • Providing defective products
  • Upcoding or unbundling
  • Double-billing for services
  • Using false certifications
  • Misusing government grant money
  • Paying kickbacks to health care providers for medical goods or services
  • Concealing ownership in a related company
  • Misrepresenting drug and medical device safety

Most healthcare fraud whistleblowers are people who work in the healthcare field. When a healthcare provider, billing employee, home health aide, or pharmaceutical worker witnesses questionable activity, they may not want to “rock the boat.” However, taking the right step in reporting fraud can put a stop to it and reward the individual who comes forward to report fraud.

Healthcare fraud may also include patients who notice inconsistencies or errors in their bills or records. However, many of these errors are attributed to mistakes or computer errors. Patients should review their insurance bills, medical records, and Medicare/Tricare/Medicaid records for suspicious entries, including:

  • Incorrect service dates
  • Repeated entries for the same procedure
  • Billing for services that were never performed
  • Providing unnecessary or unwanted procedures or products
  • Payment numbers that differ from the patient's receipts
  • Medication amounts that are different from what was provided
  • Prescription bills sharply higher than what they should be

Do You Have a Whistleblower Case?

You may have witnessed some of these potential signs of fraud, or you may have concrete evidence of fraud against the government. If you have any question about whether you may have a whistleblower case, the Schechter Legal Group is here for you. We will advise you of your rights and your options and help you pursue a whistleblower claim, and potentially obtain a reward for your courage. Contact the Schechter Legal Group today.

Contact Us

If you want to report fraud against the government but you are concerned about your future, we are here to help. We will help protect your rights as a whistleblower to obtain the reward you deserve. Contact the Schechter Legal Group today.

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